Use of the vibration perception threshold (VPT) is a simple way of detecting large-fiber dysfunction, thus identifying individuals with diabetes at risk of ulceration.
1-2Nevertheless, poor standardization of measurement limits its use in clinical practice; 3-5 furthermore, the unique normality threshold of 25 V is criticized due to the physiologic increase in VPT with age. 6 The development of devices reducing the intra-and interoperator variability in the test execution could help research and clinical practice in the identification of new relevant reference thresholds. In this context the UltraBiotesiometer Meteda contains specific features that reduce the variability of the measurements, that is, the vibration activated only under controlled pressure, five indicator lights allowing the monitoring of the pressure, and the elasticity of vibration electrically controlled in both directions. We adopted this new technologically advanced biothesiometer to assess VPT trends in subjects without sensorimotor distal symmetric polyneuropathy and identify age-specific normality thresholds.A random sample of 150 consecutive individuals have been identified among those routinely referred to one endocrinology center in Argentina. Patients were considered eligible for the study if diabetes, neuropathy, and slipped disc were excluded. Recruitment was stratified according to three age classes: <45, 45-60, >60 years. VPT was measured using UltraBiotesiometer Meteda.Normal ranges for VPT were computed using the normal approximation. The upper limit of this range was reported along with its 95% confidence intervals. Subjects with values larger than the estimated upper limit should be considered as "nonnormal." Subgroup analyses for each age class were performed. VPT values were log-transformed before analyses because their skewed distribution. A P value < .05 was considered significant. All analyses were performed using R software.Our results document that normality threshold in the overall population is lower (20 V) than that currently suggested by guidelines (25 V) and relevant differences in VPT upper limits exist according to age classes (Table 1). The normality thresholds identified cannot provide direct indications for changing clinical practice, but the clear trend and the marked differences among the upper limits in the three age classes cannot be ignored. Further longitudinal studies adopting technologically advanced devices are needed to assess the association between age-specific normality thresholds and incidence of lower limb complications.
Diffuse intrinsic pontine glioma (DIPG) is an aggressive infiltrative glioma for which no curative therapy is available. Radiation therapy (RT) is the only potentially effective intervention in delaying tumor progression, but only transiently. At progression, re-irradiation is gaining popularity as an effective palliative therapy. However, at second progression, exclusive symptomatic treatment is usually offered. Here we report two patients with DIPG at second progression who were treated with a second re-irradiation course with good response. Importantly, treatment was well tolerated with no irradiation associated acute toxicity identified.
Resumen. En este trabajo se analizó densidad, estructura poblacional, reproducción y supervivencia individual de 4 especies de plantas útiles con el fi n de determinar el estado en el que se encuentran sus poblaciones y capacidad de regeneración, así como la importancia relativa de la reproducción sexual y la propagación vegetativa para el reclutamiento de 2 de estas especies. Las poblaciones de todas las especies tienen densidades variables y están compuestas por plantas de tamaño intermedio. Las plantas de tamaño pequeño y grande son escasas. La producción de frutos varió entre las poblaciones de cada especie, aunque no se observaron diferencias en el número de semillas por fruto y la proporción de semillas germinadas. La supervivencia de las plántulas fue baja y dependió de las condiciones ambientales. La propagación vegetativa es el mecanismo más común para el reclutamiento de las especies que presentan esta forma de reproducción. Se discuten los posibles factores físicos, biológicos y humanos que podrían limitar la capacidad de regeneración de las poblaciones y su efecto sobre el aprovechamiento de estas plantas.
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